Does 44238 require prior authorization?

No, 44238 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 44238?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Gastric bypass and gastric restrictive procedures are consideredmedically necessarywhenallof the following criteria are met:
Individual is age 18 years or older;and
The recommended surgery is one of the following procedures:Biliopancreatic bypass with duodenal switch;orEndoscopic sleeve gastroplasty;orLaparoscopic adjustable gastric banding;orRoux-en-Y procedure up to 150 cm;orSingle anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S);orDuodenal jejunal bypass with gastric sleeve (DJB-SG);orSleeve gastrectomy;and
Biliopancreatic bypass with duodenal switch;or
Endoscopic sleeve gastroplasty;or
Laparoscopic adjustable gastric banding;or

ANTHEM-CG-SURG-83 — CG-SURG-83 Bariatric Surgery and Other Treatments for Clinically Severe Obesity

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